Treatment of vitiligo
Prognosis of vitiligo is poor. Significant spontaneous repigmentation is rare. Response to treatment is unpredictable and incomplete, and relapse is common.
The psychosocial impact of vitiligo on patients can be marked—refer patients for emotional and psychological support.
Consider eye and ear examination if eye and ear involvement is suspected.
Advise patients to avoid sunburn to affected areas. If eye involvement is identified, advise patients to wear sunglasses.
Cosmetic camouflage products (eg makeup products with higher coverage) can be useful.
Topical therapy is most useful in children and in patients with early and evolving vitiligo; only a small percentage of patients with established vitiligo are likely to respond to topical therapy. Response can take at least 3 months, but is unlikely if no improvement is seen by 6 months. Topical therapies can be combined.
For vitiligo not on the face or body folds, use a topical corticosteroid:
1betamethasone dipropionate 0.05% cream or ointment topically, once daily for 3 months, then review betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate
OR
1mometasone furoate 0.1% cream or ointment topically, once daily for 3 months, then review. mometasone furoate mometasone furoate mometasone furoate
A long course of potent topical corticosteroids is unsuitable for vitiligo on the face or body folds. For vitiligo on the face (eg on eyelids, or around the mouth) or body folds, use topical pimecrolimus:
pimecrolimus 1% cream topically, twice daily for 3 months1. pimecrolimus pimecrolimus pimecrolimus
If vitiligo is extensive and rapidly progressing, or if topical therapy is unsuccessful, refer to a dermatologist for advice and consideration of phototherapy. Patients typically need prolonged phototherapy treatment before vitiligo improves. There is no evidence for increased risk of skin cancers and melanoma in patients with vitiligo receiving phototherapyBae, 2020.